Revista de SIDA e investigación clínica

Introducción: El consumo de sustancias como el alcohol, el khat y el tabaco se ha convertido en uno de los principales problemas socioeconómicos y de salud pública en aumento en todo el mundo. Muchas personas en riesgo o ya infectadas por el VIH abusan del alcohol, lo que contribuye a las dificultades para prevenir la propagación de la infección y tratar a los pacientes infectados. Objetivo: El objetivo del estudio fue evaluar la prevalencia del consumo de sustancias y los factores asociados entre los pacientes con infección retroviral (RVI) en tratamiento antirretroviral (TAR) en el Hospital Universitario de Assela, Assela, Etiopía. Metodología: Se realizó un estudio transversal de junio a agosto de 2016 entre 418 pacientes con RVI que estaban en seguimiento de TAR en el Hospital Universitario de Assela. Los participantes fueron seleccionados mediante un muestreo aleatorio sistemático. Los datos sociodemográficos y otros datos relevantes se recopilaron mediante un cuestionario semiestructurado. Los datos se codificaron, limpiaron e ingresaron utilizando Epi Info 3.5.3 y luego se exportaron al paquete estadístico para las ciencias sociales (SPSS) versión 21 para su posterior análisis. Se utilizó estadística descriptiva y análisis de regresión logística. Resultados: La prevalencia del consumo de sustancias al menos una vez en la vida entre los pacientes con IVR fue del 27,5%, mientras que la prevalencia del consumo actual de sustancias fue del 3,8% y el alcohol fue la droga de abuso predominante. El consumo de alcohol fue el factor predictivo fuerte del abuso de sustancias entre los encuestados, siendo hombre y por parte de amigos o familiares. Conclusión y recomendación: Este estudio reveló que la prevalencia del consumo de sustancias entre los pacientes con IVR fue significativa. Recomendamos que la creación de conciencia sobre la influencia del consumo de sustancias en el VIH por parte de los profesionales de la salud tenga un beneficio invaluable.

Stevens-Johnson syndrome (SJS) and its more advanced form, Toxic Epidermal Necrolysis (TEN) are severe adverse cutaneous reactions that predominantly involve skin and mucous membranes. In view of the current dearth of documented knowledge, this study the first of its kind from India was designed to categorically distinguish and compare the different associated factors and clinical manifestations relevant to the development of SJS/TEN syndrome among the immunocompromised (Human Immunodeficiency Virus 1 seropositive) patients in Eastern India. 16 out of 29 patients (55.1%) were found to be suffering from drug induced SJS or TEN, while the rest (44.8%) had severe pathogenic involvements. Neviraprine use was found to be the major cause among drug involved SJS (53.8%) and TEN (66.66%) cases followed by allopurinol use. The frequency of incidence of kidney disease (67% in SJS and 54% in TEN) and neurological impairment (42% SJS and 37%TEN) was found to be significantly higher among the SJS patients whereas that of hepatitis (38% SJS and 47% TEN) , ocular dysfunction (49% SJS and 63% TEN) and pulmonary dysfunction (47% SJS and 53% TEN) were higher among the TEN patients. This study also had another prominent motive, which is to elucidate the possible role of human cytomegalovirus in triggering the exfoliative inflammatory disease conditions among these patients. The incidence rate of SGPT and SGOT were significantly higher in TEN patients than in SJS (p=0.001 and p=0.002) . Mean sodium level in blood was within normal range in both the groups whereas potassium and chloride levels were much higher than normal Out of the 29 HIV seropositive patients with SJS/TEN we studied, only 4 (13.7%) had an active HCMV infection. In detailed study of the associated laboratory and clinical parameters, cytokine analysis profile, Immuno-histologic findings and rigorous analysis of the investigation reports identified HCMV infection as the probable trigger behind SJS/TEN development in these patients.

Background: Despite the recent advances in antiretroviral therapy, human immunodeficiency virus type 1 (HIV-1) remains a global health threat. The aim of this study was evaluated the efficacy of a four-drug induction antiretroviral therapy (ART), including raltegravir (RAL), on the rapidity of suppression of plasma HIV-RNA below detectable concentrations and its impact on immunological recovery. Methods: In this single centre, randomized prospective trial, 32 naïve HIV+ patients at the same clinical stage were enrolled and randomized for baseline viral load: sixteen subjects started ART with four antiretroviral drugs including RAL, while the remaining patients started the same therapy without RAL. Viro-immunological and metabolic parameters, indexes of hepatic and renal functionality were measured at baseline (T0) and after three (T3), six (T6) and twelve months (T12) from therapy introduction. Results: We observed a faster viral drop in the group under RAL-therapy with respect to the other group. At the first month (T1) of therapy, the HIV-RNA was significantly lower in the patients receiving RAL-therapy (p<0.05). Immunological recovery was higher in patients with RAL than in those on other therapy at all detection times, with a significant increase at T3, T6 and T12 (p=0.02). Conclusion: In this study, we found, for the first time, a rapid and significant improvement in CD4+ T cells count in patients with four drug induction therapies. The four-drug regimen was safe, well tolerated and also associated with a rapid decay of plasma HIV-RNA levels.

Background: Voluntary Counseling and Testing (VCT) is the key entry point to prevention, care, treatment and support services, where people learn whether they are infected and are helped to understand the implications of their HIV status and make informed choices for the future. Objective: The main objective of this study was to assess voluntary counseling and testing utilization and associated factors among Arba Minch University students. Method: An Institution-based cross-sectional study design with quantitative data collection method was employed among 764 students drawn from selected departments of Arba Minch University; by using multi-stage sampling technique. Data was analyzed by using SPSS version 20. Results: A total of 764 people responded the questionnaire out of 805 proposed study participants with the response rate of 94%, of whom 77.6% were male. From the study participants 97.9% were knowledgeable about HIV transmission and prevention. The prevalence of HIV testing was 61.5% (95% CI=0.58, 0.65). The findings also showed that the participants who are knowledgeable about HIV (AOR=4.46, 95% CI=2.00, 9.89), who are willing to have VCT (AOR=3.22, 95% CI=1.98, 5.25), who heard about presence of confidential testing (AOR=3.66, 95% CI=2.38, 5.62) and who had sex (AO=1.71, CI=1.19, 2.48) were more likely to be tested. Feeling at risk, fear of a positive result and fear of being stigmatized were reported as being the main barriers to VCT utilization. Conclusion: Knowledge about HIV and VCT, willingness to have VCT and presence of confidential testing were independent factors identified as predictors for increased VCT service utilization. Recommendation: More emphases should been given by concerned governmental and non-governmental organizations on independent factors identified as predictors for increased VCT service utilization and removing the main barriers to voluntary counseling and testing.

Introduction: In the case Human Immune Deficiency virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), prison conditions not only contribute to the risk of transmission, it also hastens the progression of HIV and deterioration in the health of prisoners living with HIV/AIDS. Prisons typically comprise marginalized sections of society and at high nutritional risk due to lack of diet diversity, as these prisoners depend on few kinds of food for a long time and in a situation, adequacy of nutritional requirement is a great issue of concern. Objective: To assess nutritional status and associated factors among prisoners living with HIV/AIDS in Kality prison, Addis Ababa, Ethiopia, 2016. Method: Institution based cross sectional study design was conducted among randomly selected 412 prisoners on pre Anti-Retroviral Therapy and Anti-Retroviral Therapy in Kality prison, Addis Ababa, Ethiopia from February to March, 2016. The data entered to Epi-info version 7.0 and export to Statistical Package for Social Science version 20.0 for further analysis. Descriptive statistics, binary and multivariable logistic regression analysis were employed to identify nutritional status and associated factors that affect nutritional status of prisoners living with HIV/AIDS. Results: The overall magnitude of malnutrition was found to be 43% among prisoners living with HIV/AIDS. Female respondents were 92% times less likely to develop malnutrition than male respondents (AOR 0.08 [95% CI 0.02, 0.42) and those who were in the age range of ≥ 50 were eight times more likely to be malnourished with (AOR 8.68 [95% CI 1.59, 47.28]) than other age groups. Conclusion: The prevalence of underweight was very high among prisoners living with HIV/AIDS in this area. Recommendation: The prison administrative body should give emphasis on increasing diversified food and Proper nutritional assessment should be the vital part of HIV care management by health workers.

Background: Co-infection of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are very prevalent and the primary cause for morbidity and mortality among patients with Human immunodeficiency Virus (HIV). The aim of this study was to assess the magnitude of HBV and HCV infection and its association with liver and renal function, and CD4+ T cell levels of highly active anti-retroviral therapy (HAART) taking patients. Method: A hospital based cross sectional study was conducted at Zewditu Memorial Hospital. Participants’ sociodemographic and clinical information were collected from the anti-retroviral therapy (ART) database. Blood samples were collected from 384 volunteer, patients taking HAART for at least 1 year to investigate CD4, HBSAg, HCVAb, liver and renal function. Data was entered and analyzed by SPSS version 20 and p value less than 0.05 was taken as statistically significant. Results: Of the 384 participants, 222 (57.81%) were females, and 168 (43.75%) were in age group 30-39 years. Overall burden of HBV and HCV were 21 (5.7%). Co-infection rates of HBV-HIV, HCV-HIV and HBV-HCV-HIV were 18 (4.7%), 4 (1%) and 1 (0.2%), respectively. Co-infected study participants had significantly raised mean liver enzyme levels (AST, ALT and ALP) than mono-infected ones. There was no statistically significant difference for renal function parameters between mono-infected and co-infected HAART taking patients. Co-infected HIV patients had lower mean level of CD4 compared to mono-infected ones. Conclusion: HBV and HCV co-infected HIV patients are more likely to have abnormal liver enzyme levels and tend to have low mean CD4 count than mono-infected HIV patients. Large scale cohort study is recommended for consolidating the current findings.

The diagnosis of 90% of people with HIV is the first target of United Nations UNAIDS 90:90:90 visions for 2020, to end the AIDS epidemic by 2030. Antenatal HIV testing is an important step forward in achieving this and the elimination of mother-to-child transmission (EMTCT) of HIV, which is validated by world health organization. This is possible through universal antenatal screening for HIV and effective intervention. A screening tool, useable as a point-of-care (POC) test is essential for HIV testing in the antenatal clinics. We evaluated the performance of SD Bioline HIV/syphilis Duo rapid test kits in this regard, in Nepal and found it a good screening tool with added opportunity for simultaneous diagnosis of HIV and syphilis. Currently, as it is commercially available at affordable cost, screening of pregnant women for syphilis and HIV has become feasible with the potential to form an integral part of improving maternal and child health.

Objective: Health products can be marketed in Brazil after registration in the Health Ministry. Male condoms are considered health products and are compulsorily certified following RDC 62/2008 regulation. Condom sanitary control must follow the certification regulation however is impractical due to great sample size (548 units for each lot). An appropriate technical surveillance should be designed to condom sanitary control. Methods: Two different batches were purchased directly from the manufacturer. And three different brands, being one of them similar to the batches acquired directly from the manufacturer, were acquired in several establishments in Brazil, and the total amount was the sum of several different lots for each of the chosen brands. It was incorporated geoprocessing technique to maintain the traceability of the lots collected in the trade. Analyzes were performed according to the criteria established in Brazilian National Health Oversight Agency Resolution no. RDC 62/2008. Non compliant samples results were sent to Sanitary Surveillance and actions were requested to collect non compliant lots samples, according to the sampling established by RDC 62/2008. Samples were analyzed by the laboratory. The reports are sent to the Sanitary Surveillance for the necessary measures. Results: It was observed that three different lots found nonconformity in at least one of the analyzes and, in some cases, as our sample N is a variation of lots of a given brand, the non-compliance occurred in a lot that was considered separately, do not we would have enough to perform the analyzes. Conclusion: The development of this technical surveillance model provides the monitoring actions of male condoms throughout the country, since from a perspective of Sanitary Surveillance, a unique nonconforming unit has serious implications for public health.